David Hoppe

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:: HIP 2.0

Obamacare’s slip is showing

by David Hoppe

For months, some of us have been pounding Gov. Mike Pence over his refusal to take Federal dollars available as part of the Medicaid expansion called for under Obamacare, aka the Affordable Care Act.

This, Pence said, wouldn’t be “the Hoosier Way.”

Meanwhile, Pence was busy negotiating with the Feds, arguing that he had a better idea about how to expand health care coverage in Indiana. He called this the Healthy Indiana Plan 2.0. Started under Mitch Daniels, the HIP is a health savings account for poor people. It requires those who use it to pay into the program on a monthly basis that can range from as little as a dollar a month to $27.

This amounts to about two percent of family income for those affected.

At first blush this seems like a pretty good deal. Indeed, it appears to make the Affordable Care Act truly affordable. As many as 350,000 currently uninsured Hoosiers may now be able to get health coverage.

This is being touted as a big victory for Pence. It supposedly shows how an ostensibly liberal government program — Obamacare — can be retooled on the anvil of conservative values.

As Pence said, “I believe Medicaid is not a program we should expand. It’s a program we should reform — and that’s exactly what we’re accomplishing. HIP 2.0 is not intended to be a longterm entitlement program. It’s intended to be a safety net that aligns incentives with human aspirations.”

The notion that health care is something to be incentivized means that, for Pence, the ability to go to a doctor when you are sick, and that you can get the care you need without having the rest of your life turned upside down by the cost, is a privilege, not a right.

What’s more, Pence’s statement reflects the view that health insurance and having a job are linked, that to get one, you should have the other.

Pence’s ability to bring the Obama administration to heel on this issue is actually less a win for conservative values than a further demonstration of Obamacare’s intrinsic flaws.

The fact that there was no logical or policy-based reason for the Feds to deny Pence’s proposal only shows the extent to which Obamacare fails to address our healthcare system’s most outmoded and unwieldy feature: its insistence that employment and health insurance be co-dependent.

By perpetuating the employer-healthcare linkage, instead of pressing for the equivalent of Medicare for everybody, the Obama administration has enabled conservatives like Pence to continue to think of healthcare as something people earn through employment. This makes it morally acceptable in their view to use health insurance as a carrot, or incentive, to get people into the workforce.

It also assumes that poor people are poor by choice, and a lot of other things having to do with the way society works (or doesn’t) that don’t necessarily line up with reality as many people actually experience it.

Some analysts say the bureaucratic hoops associated with HIP 2.0 are so daunting they may discourage qualified people from enrolling in the program. What, I wonder, is conservative about that?